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8  L— 1911  21-392,  11,  5,000  (P) 

THE    ASSOCIATION 


OF 


TUBERCULOSIS  CLINICS 


OF    THE 


CITY  OF  NEW  YORK 


ISSUED   BY   THE   DEPARTMENT   OF   HEALTH  FOR  USE 
BY  THE  ASSOCIATION  OF  TUBERCULOSIS  CLINICS 


1911 


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THE     ASSOCIATION     OF     TUBERCULOSIS     CLINICS 

OF    THE    CITY    OF    NEW    YORK 


DIRECTORS  AND  OFFICERS 

JAMES  ALEX.  MILLER,  M.  D.,  President 

JOHN  H.  HUDDLESTON,  M.  D.,  Vice-President 

LAWRENCE  VEILLER,  Secretary 

MRS.  HERMANN  M.  BIGGS 

F.  MORRIS  CLASS,  M.  D. 

MRS.  J.  BORDEN  HARRIMAN 

AUSTIN  W.  HOLLIS,  M.  D. 

A.  JACOBI,  M.  D. 

MISS  BLANCHE  POTTER 
HENRY  L.   SHIVELY,  M.  D. 
ANTONIO  STELLA,  M.  D. 

B.  H.  WATERS,  M.  D. 

FRANK  H.   MANN,  Assistant  Secretary 

F.  ELISABETH  CROWELL,  Executive  Secretary 


The  Association  of  Tuberculosis  Clinics 


The  Association  op  Tuberculosis  Clinics  is  the  outgrowth 
of  an  experiment  undertaken  by  the  Committee  on  the  Preven- 
tion of  Tuberculosis  of  the  New  York  Charity  Organization 
Society  to  demonstrate  the  possibilities  of  effective  home  treat- 
ment of  tuberculosis  in  New  York  City.  The  experiment  was 
conducted  by  a  special  committee  consisting  of  the  chiefs  of 
several  of  the  tuberculosis  clinics  in  the  city  and  representatives 
of  the  Charity  Organization  Society.  The  close  association  of 
these  chiefs  of  the  tuberculosis  clinics  and  the  co-operation 
between  them  and  the  social  and  benevolent  organizations  in  the 
city  led,  at  the  conclusion  of  the  experiment  in  January,  1908, 
to  the  formation  of  a  separate  organization,  composed  of  the 
representatives  of  nine  special  tuberculosis  clinics,  having  as  its 
purpose  the  further  organization  and  development  of  tubercu- 
losis clinics  looking  toward  the  ultimate  dispensary  control  of 
the  disease. 

MEMBERSHIP. 

Clinics  eligible  for  membership  in  the  Association  must  be  pro- 
vided with :  (a)  a  separate  class  for  tuberculosis  cases ;  (b)  a 
graduate  nurse  assigned  to  this  class  for  the  purpose  of  main- 
taining supervision  over  the  homes  of  these  tuberculosis  cases; 
(c)  a  district  within  which  the  work  of  the  class  is  limited  for 
new  cases. 

Members  are  elected,  and  there  are  no  dues. 

The  number  of  active  members  corresponds  to  the  number  of 
clinics  in  the  Association,  each  active  member  being  the  repre- 
sentative of  a  particular  clinic. 


All  physicians  engaged  in  the  treatment  of  tuberculosis,  and 
representatives  of  all  associations  interested  in  tuberculosis  work, 
are  eligible  for  associate  membership. 

PURPOSES  OF  THE  ASSOCIATION. 

First. — To  organize  dispensary  control  of  pulmonary  tuber- 
culosis in  New  York  City. 

Second. — To  develop  a  uniform  system  of  operation  of  such 
dispensaries  as  are  organized  for  this  purpose. 

Third. — To  retain  patients  under  observation  until  they  are 
satisfactorily  disposed  of,  and  to  prevent  them  drifting  from  one 
dispensary  to  another. 

Fourth. — To  establish  and  maintain  a  district  system  of  dis- 
pensary treatment. 

Fifth. — To  facilitate  the  attendance  of  patients  at  the  dispen- 
sary most  convenient  to  their  homes. 

Sixth. — To  facilitate  the  work  of  visiting  nurses  in  the  homes 
of  patients. 

Seventh. — To  provide  for  each  patient  requiring  it,  assist- 
ance by  special  funds  or  benevolent  organizations,  and  proper 
hospital  or  sanatorium  care. 

Eighth. — To  co-operate  with,  and  assist  as  far  as  possible, 
the  Department  of  Health  in  the  supervision  of  pulmonary  tuber- 
culosis. 

WHAT  HAS  ALREADY  BEEN  ACCOMPLISHED. 

Medical  Care  and  Home  Supervision  Combined. 

Twenty-two  special  clinics  for  the  treatment  of  pulmonary 
tuberculosis  have  been  established  in  Manhattan,  The  Bronx  and 
Richmond.  At  each  of  these  clinics  facilities  are  provided  to  sep- 
arate tuberculosis  from  other  diseases  and  to  treat  these  patients 
more  carefully  and  skilfully  than  is  possible  in  a  general  dispen- 
sary. Visiting  nurses  follow  up  the  patients  in  their  homes  and 
thus  insure  the  execution  of  the  instruction  and  advice  given  at 


the  clinic.  Other  members  of  the  family  are  seen  and  all 
suspicious  cases  are  sent  to  the  clinic  for  physical  examination. 
Thorough  and  repeated  instruction  educates  the  patients  and  their 
families  in  the  essentials  of  the  prevention  and  treatment  of 
tuberculosis.  Assistance  in  the  form  of  clothing,  payment  of  rent, 
extra  nourishment  or  general  charitable  relief  is  rendered  either 
by  special  funds  administered  by  the  clinic  nurse  or  through 
proper  benevolent  organizations.  Hospital  or  sanatorium  care  is 
secured  for  those  who  need  such  treatment. 

A  District  Plan  and  Its  Advantages. 

For  more  than  two  years  a  plan  has  been  in  operation  by  which 
the  city  has  been  apportioned  by  districts  between  the  various 
tuberculosis  clinics.  Patients  are  required  to  attend  the  clinic  in 
the  district  of  their  residence,  and  whenever  application  is  made 
to  the  wrong  clinic  the  patient  is  promptly  referred  to  the  clinic 
in  the  district  in  which  he  lives. 

This  scheme  enables  the  visiting  nurse  to  supervise  the  patients 
much  more  effectively  by  facilitating  frequent  visits,  and  insures 
treatment  for  the  patient  within  convenient  distance  of  his  home. 
It  thus  makes  for  greater  efficiency  of  service  by  an  economy  of 
time  and  energy.  Theoretical  objections  to  this  district  system 
have  not  materialized  in  practice. 

Co-operation  Between  the  Various  Clinics. 

By  means  of  the  Association  the  various  physicians  have  been 
brought  closely  together  and  much  has  been  accomplished  toward 
a  harmonious  and  effective  system  of  management  of  pulmonary 
tuberculosis.  A  remarkable  unity  of  purpose,  the  satisfaction  of 
better  accomplishment  and  an  enthusiasm  for  the  future  have 
resulted.  Acquaintance  and  comparison  have  tended  to  the  gen- 
eral adoption  of  approved  methods  of  education,  supervision, 
relief  and  treatment  of  patients. 

CO-OPERATION    WITH    SOCIAL    AND    CHARITABLE    ORGANIZATIONS. 

Through  its  associate  membership  the  Association  endeavors 
to  interest  all  the  various  organizations  in  the  city  which  come 
in  contact  with  this  disease.  Physicians  thus  widen  their  horizon 
in  accordance  with  the  comparatively  recent  recognition  of  the 


large  social  factor  concerned  in  the  study  of  this,  as  well  as  many- 
other  diseases.  Social  workers,  on  the  other  hand,  are  assured 
of  competent  advice  and  a  reliable  medical  basis  for  their  work. 

The  following  list  of  societies  and  institutions  represented  in  the 
associate  membership  shows  to  what  extent  such  co-operation 
has  been  secured: 

Association  for  Improving  the  Condition  of  the  Poor,  Amer- 
ican Red  Cross,  Bellevue  and  Allied  Hospitals,  Bellevue  Hos- 
pital Auxiliary,  Brooklyn  Association  of  Tuberculosis  Clinics, 
Charity  Organization  Society,  Department  of  Education,  Depart- 
ment of  Health,  Department  of  Public  Charities,  Federation  of 
Catholic  Charities,  Federation  of  Churches,  Gouverneur  Hos- 
pital Auxiliary,  Health  Department  Auxiliaries,  Italian  Benev- 
olent Association,  Loomis  Sanatorium,  New  York  Diet  Kitchen 
Association,  Nurses'  Settlement,  Nurses'  Association,  Otisville 
Sanatorium,  Riverside  Hospital,  St.  George's  Tuberculosis 
Class,  St.  Joseph's  Hospital,  Societe  Francaise  de  Bienfaisance, 
State  Department  of  Labor,  Society  of  St.  Vincent  de  Paul, 
Stony  Wold  Sanatorium,  Union  Settlement,  United  Hebrew 
Charities,  Vanderbilt  Clinic  Women's  Auxiliary,  Visiting 
Nurses'  Association  of  Presbyterian  Hospital,  Women's 
Auxiliary  of  Morgagni  Clinic,  Women's  Auxiliary  of  St.  Bar- 
tholomew's Clinic  and  Women's  Committee  Civic  Federation. 

CO-OPERATION  WITH    GENERAL  DISPENSARIES. 

A  complete  canvass  of  all  the  dispensaries  in  the  city  has  been 
made  to  ascertain  their  attitude  toward  the  work  of  the  Asso- 
ciation. The  results  show  a  general  approval  of  its  methods  and 
plans. 

The  method  of  co-operation  proposed  by  the  Association  in  its 
campaign  to  secure  active  affiliation  with  those  dispensaries 
offered  two  alternatives: 

Either,  That  the  general  dispensary  establish  a  special  tuber- 
culosis clinic,  with  a  visiting  nurse,  assume  responsibility  for  a 
district  and  join  the  Association,  subject  to  its  rules  and  regula- 
tions ; 

Or,  If  this  be  not  feasible,  that  the  general  dispensary  decline 
to  treat  cases  of  pulmonary  tuberculosis  but  refer  such  patients  to 
the  proper  clinic  of  the  district  of  their  residence — maps  and 
cards  for  this  purpose  to  be  furnished  by  the  Association. 


Establishment  of  Children's  Clinics. 

Believing  that  the  early  recognition  of  tuberculosis  in  children, 
followed  by  careful  observation  and  adequate  treatment,  is  one 
of  the  strongest  factors  in  the  ultimate  control  and  eradication 
of  tuberculosis,  the  Association  has  strongly  urged  the  establish- 
ment of  special  children's  clinics  in  connection  with  the  tubercu- 
losis clinics  for  adults.  Four  of  the  dispensaries  are  now  main- 
taining these  special  tuberculosis  clinics  for  children. 

Formation  of  Women's  Auxiliaries. 

Nine  dispensaries  have  organized  Women's  Auxiliaries  whose 
chief  function  is  to  make  possible  and  thorough  an  efficient 
social  service  for  the  tuberculosis  cases  who  are  under  the  clinic 
care.  Destitute  cases  are  helped  from  a  special  fund.  Assistance 
is  given  by  paying  rent,  furnishing  outfits,  and  if  necessary  pay- 
ing carfares  to  and  from  sanatoria.  Special  diet  is  provided. 
When  necessary,  the  work  of  the  clinic  is  supplemented  by  pay- 
ing the  salaries  of  additional  nurses  and  by  contributing  toward 
the  expenses  of  the  day  camps. 

Establishment  of  Day  Camps. 

Connected  with  five  of  the  clinics  are  day  camps  for  the  use 
of  incipient  and  moderately  advanced  tuberculosis  cases  who  have 
the  time  and  are  willing  to  spend  a  certain  part  of  the  day  in 
taking  the  rest  cure  in  the  open  air  but  who  are  unable  to  leave 
the  city.  Three  of  these  day  camps  are  on  ferry-boats.  An- 
other is  on  the  roof  of  one  of  the  dispensaries.  Nurses  are  in 
immediate  charge  of  the  patients,  and  regular  visits  are  made 
by  physicians  in  attendance.  In  connection  with  these  day  camps 
there  are  conducted  fresh  air  schools  under  the  charge  of  teachers 
appointed  by  the  Department  of  Education  for  those  tuberculosis 
children  who  have  been  excluded  from  the  public  schools.  Ap- 
plicants for  admission  to  the  day  camps  are  admitted  through 
any  of  the  clinics  belonging  to  the  Association. 

Four  of  these  day  camps  also  make  provision  for  caring  for 
patients  at  night. 

One  clinic  maintains  in  winter  a  special  night  camp. 


Organization  of  Nurses  Engaged  in  Clinic  Work. 

A  Nurses'  Association  of  the  Association  of  Tuberculosis 
Clinics  has  been  organized,  the  object  of  which  is  to  secure  co- 
operation and  promote  uniformity  of  the  nurses'  work  in  con- 
nection with  the  tuberculosis  dispensaries,  and  by  regular  monthly 
conferences  to  keep  the  nurses  informed  of  the  best  methods  by 
which  such  co-operation  and  uniformity  may  be  secured. 

In  addition,  by  means  of  short  talks  by  the  heads  of  various 
philanthropic  agencies,  frequent  opportunity  is  afforded  for  the 
nurses  to  become  acquainted  with  the  best  methods  of  co-oper- 
ating with  the  various  relief  agencies  in  the  city. 

Sanitary  Supervision  of  Cases  of  Pul- 
monary Tuberculosis  at  Their  Homes  by 
Nurses    of    the    Department    of    Health. 

All  registered  tuberculosis  cases,  except  those  in  hospitals,  sana- 
toria, or  other  institutions,  or  those  under  the  care  of  a  private 
physician,  are  supervised  in  their  homes.  Responsibility  for  this 
supervision  is  divided  between  the  tuberculosis  clinics  and  the 
Department  of  Health.  All  clinic  cases  are  supervised  by  clinic 
nurses.  All  "at  home"  cases,  that  is,  cases  not  regularly  attend- 
ing the  clinic,  not  in  an  institution,  or  under  a  private  physician's 
care,  are  under  the  immediate  supervision  of  the  Department  of 
Health,  and  are  visited  at  least  once  a  month. 

For  the  information  of  the  members  of  the  Association,  a 
description  is  here  given  of  the  work  of  the  district  tuberculosis 
nurses  of  the  Department  of  Health. 

In  each  clinic  district  a  staff  of  district  nurses  is  maintained, 
charged  with  the  sanitary  supervision  of  cases  of  pulmonary 
tuberculosis  in  that  district.  These  nurses  report  daily  at  the 
tuberculosis  clinic  of  their  district,  and  there  receive  all  assign- 
ments. One  nurse  is  detailed  as  "Captain"  of  the  district,  and 
acts  as  the  official  intermediary  between  the  tuberculosis  clinic 
and  the  Department  of  Health.  Each  morning  she  telephones  to 
the  Department  of  Health  the  daily  report  of  the  clinic,  and 
receives    in   the    same   manner   all   information    received    at    the 


Department  of  Health  during  the  preceding  twenty-four  hours 
regarding  all  cases  of  tuberculosis  in  the  district.  This  latter 
information  is  at  once  reported  to  the  tuberculosis  clinic. 

In  case  of  death  or  removal  of  tuberculosis  patients,  the  dis- 
trict nurses  order  the  necessary  disinfection  of  the  premises 
and  bedding;  they  make  arrangements  for  the  admission  of  ad- 
vanced cases  to  hospitals  and  incipient  cases  to  sanatoria ;  they 
investigate  all  complaints  made  by  citizens,  see  that  the  sanitary 
regulations  of  the  Department  of  Health  regarding  the  care  of 
expectoration  are  observed,  and  use  their  authority  to  induce 
"delinquent"  cases  to  resume  attendance  at  the  clinic ;  they  visit 
the  families  of  patients  in  hospital  at  stated  intervals;  and  each 
nurse  maintains  a  complete  and  correct  index  of  all  cases  of 
pulmonary  tuberculosis  living  in  her  district,  which  is  at  all  times 
accessible  to  the  nurses  and  physicians  at  the  clinic.  Every  effort 
is  made  to  secure  complete  and  harmonious  co-operation  between 
the  district  nurses  of  the  Department  of  Health  and  the  tuber- 
culosis clinics. 

RULES   OF   THE   ASSOCIATION. 

I. — Maintenance  of  the  District  System. 

i. — Each  applicant  for  admission,  who  has  already  been 
admitted  to  the  dispensary  of  the  district  in  which  he  or 
she  lives,  shall  be  refused  admission  to  any  other  dis- 
pensary, and  referred  back  to  the  dispensary  of  his  or 
her  district. 

2. — Patients  removing  from  one  dispensary  district  to 
another  shall  be  considered  transferred  cases. 

All  cases  so  transferred  are  at  once  reported  through 
the  district  "Captain"  to  the  Department  of  Health,  which 
notifies  the  proper  clinic  by  telephone  within  twenty-four 
hours.  All  such  transferred  cases  are  immediately  visited 
by  a  Department  of  Health  nurse  and  urged  to  attend  the 
proper  clinic ;  should  they  not  do  so  within  one  week  they 
are  again  visited  for  the  same  purpose,  but  are  not  re- 
visited by  the  Health  Department  nurse  while  they  are  in 
attendance  at  the  proper  clinic.     (See  Rule  VI,  Sec.  B.) 

9 


Where  patients  have  been  under  observation  at  the 
original  clinic  for  some  time,  the  results  of  diagnostic 
tuberculin  tests,  sputum  test  and  temperature,  pulse  and 
weight  observations  and  a  brief  description  of  the  loca- 
tion of  lesion  are  to  be  forwarded  by  mail  to  the  proper 
clinic  on  a  special  card  for  that  purpose. 

3. — Each  applicant  who  lives  outside  the  district  shall 
be  examined,  and  if  positive  or  suspicious,  shall  be  trans- 
ferred at  once  to  the  proper  dispensary. 

4. — Cards  containing  address  and  hours  of  the  clinic  to 
which  the  patient  is  being  transferred  shall  be  given  to 
him,  and  a  careful  explanation  made  of  the  reason  of  the 
transfer. 

Except  :  When  by  reason  of  employment  certain  hours 
of  attendance  are  impossible,  or  in  certain  exceptional 
instances  approved  by  the  physician  in  charge  of  the  dis- 
pensary, a  patient  may  be  treated  in  other  than  his  proper 
district  dispensary. 

5. — Not  later  than  one  week  after  the  first  visit  of 
every  new  or  transferred  tuberculous  patient,  the  nurse 
of  the  clinic  shall  visit  the  patient. 

Except  :  That  dispensary  patients  who,  in  the  judgment 
of  the  physician  in  charge,  would  suffer  loss  of  position  or 
other  hardship  by  reason  of  the  nurse's  visit,  may  be  re- 
ported to  the  Department  of  Health  as  private  cases  by 
the  physician  in  charge  who  will  assume  all  responsibility 
for  such  action,  supervising  the  home  conditions,  and  sub- 
mitting monthly  reports  to  the  Department  of  Health,  as 
required  by  law. 

II. — "Not  Found"  Cases. 

Should  the  patient  be  not  found,  this  fact  shall  be  re- 
ported the  following  morning  to  the  Department  of  Health 
"Captain"  for  the  district,  who  will  endeavor  to  obtain  the 
correct  address  from  the  dispensary  of  original  applica- 
tion, and  will  report  the  same  to  the  clinic. 


10 


III. — LODGING-HOUSE  CASES. 

All  cases  (except  those  living  in  licensed  lodging-houses) 
whom  for  any  reason  it  is  impossible  for  the  clinic  nurse 
to  visit  in  their  homes,  shall  be  reported  to  the  Depart- 
ment of  Health,  Division  of  Communicable  Diseases, 
which  will  supervise  these  patients  by  its  inspectors.  Such 
cases,  however,  shall  not  be  considered  "delinquent"  cases 
unless  they  fail  to  attend  the  dispensary,  as  provided  in 
Section  IV  (A). 

IV. — "Delinquent"  Cases. 

A.  Each  patient  for  any  reason  omitting  to  return  to 
his  or  her  proper  dispensary  for  a  period  of  one  month 
(except  while  a  resident  in  hospital,  sanatoria  or  out  of 
town)  shall  be  reported  to  the  Department  of  Health  Cap- 
tain as  a  "delinquent"  case. 

Except  :  When  a  case  is  well  known  and  supervised  by 
the  visiting  nurse,  and  for  reasons  sufficient  and  satisfac- 
tory to  the  physician  in  charge,  cannot  come  regularly  to  a 
dispensary. 

B.  Should  any  patient,  except  those  found  to  be  under 
the  care  of  private  physicians,  refuse  for  any  reason  to 
attend  his  or  her  proper  dispensary,  such  patient  shall  then 
be  considered  a  "delinquent"  case. 

C.  Responsibility  for  "delinquent"  cases  will  be  as- 
sumed by  the  Department  of  Health,  and  all  such  cases, 
except  those  found  to  be  under  the  care  of  physicians  as 
private  patients,  will  be  kept  under  observation  by  a  De- 
partment nurse,  who  will  endeavor  to  secure  the  patient's 
return  to  his  or  her  proper  dispensary. 

V. — Applicants  for  Hospitals  and  Sanatoria. 

As  far  as  possible,  each  patient  shall  be  furnished  with 
medical  and  other  assistance,  through  the  agencies  of  the 
dispensary  district  in  which  he  or  she  lives. 


n 


All  applicants  for  hospital  or  sanatorium  care  are  to  be 
referred  to  the  Tuberculosis  Hospital  Admission  Bureau 
at  426  First  Avenue,  Borough  of  Manhattan.  Hours,  9 
A.  M.  to  6  P.  M.  daily,  except  Sundays.  Through  this 
Bureau  must  pass  all  cases  of  tuberculosis  admitted  to 
Bellevue  and  Allied  Hospitals  (except  emergency  cases), 
the  hospitals  of  the  Department  of  Charities  and  the  De- 
partment of  Health,  and  Otisville  and  Ray  Brook  Sana- 
toria.    (Including  cases  of  forcible  removal.) 

Applications  for  admission  to  Riverside  Hospital  must 
be  accompanied  by  a  voucher  that  tubercle  bacilli  have 
been  found  in  the  sputum  within  at  least  two  weeks  of 
the  date  of  application. 

Otisville  Sanatorium  of  the  Department  of  Health,  and 
the  New  York  State  Hospital  for  Incipient  Tuberculosis  at 
Ray  Brook,  are  primarily  for  non-complicated  first  stage 
cases  of  pulmonary  tuberculosis.  Patients  must  be  in 
favorable  physical  condition,  of  good  character  and  disposi- 
tion, and  residents  of  New  York  City  for  at  least  one  year; 
citizens  of  the  United  States  are  given  preference  over  non- 
citizens.  Patients  are  required  to  furnish  a  suitable  outfit 
of  clothing,  etc.  Every  suitable  case  is  to  be  referred  to 
the  Tuberculosis  Hospital  Admission  Bureau,  by  means  of 
the  special  reference  cards  (71  L)  furnished  for  that  pur- 
pose. These  cards  must  be  forwarded  in  duplicate,  and 
must  give  the  essential  data  regarding  the  case,  at  least 
two  records  of  the  temperature  and  pulse,  and  the  results 
of  examinations  of  sputum  and  urine.  These  cards  are  * 
to  be  mailed  to  the  Admission  Bureau,  at  426  First 
Avenue.  When  vacancies  occur,  the  applicants  are  notified 
to  call  for  final  examination.  If  found  to  be  suitable  for 
admission,  each  case  is  placed  upon  the  waiting  list  in 
the  order  of  its  original  application  at  the  clinic  from 
which  it  was  referred.  Each  patient  after  completion  of 
the  examination  and  observation  required,  shall  return, 
pending  action  in  his  case,  to  the  proper  dispensary. 


12 


VI. — Co-operation  With  the  Department  of  Health. 

A.  Each  dispensary  shall  furnish  daily  to  the  Depart- 
ment of  Health  "Captain"  the  names  and  addresses  of  all 
new  cases  of  tuberculosis  diagnosed  at  its  last  session; 
all  discharges  for  non-attendance  or  as  cured ;  all  cases 
transferred  as  not  living  in  the  clinic  district;  all  changes 
of  addresses  within  the  district;  and  cases  not  found  by 
the  clinic  nurses  at  the  address  given. 

B.  No  case  of  tuberculosis  reported  as  being  under 
treatment  is  visited  by  Department  of  Health  physicians 
or  nurses,  except  for  the  following  reasons:  complaint 
made  by  citizens  or  inspectors;  investigation  as  to  exclu- 
sion from  school ;  investigation  as  to  suitability  for  dis- 
charge from  Otisville  Sanatorium  or  other  institutions; 
and  in  cases  of  removal  or  death,  in  order  that  the  neces- 
sary disinfection  of  the  premises  may  be  ordered. 

C.  Each  dispensary  shall  endeavor  in  every  possible 
way  to  assist  in  the  prevention  of  tuberculosis,  to  conform 
to  the  requirements  of  the  Department  of  Health,  to  prop- 
erly manage  and  dispose  of  the  patients  coming  under  its 
observation,  and  to  further  the  development  of  an  ade- 
quate, efficient  and  uniform  system  for  the  care  of 
pulmonary  tuberculosis. 

VII. — Reports  to  the  Association. 

Each  dispensary  shall  furnish  the  office  of  the  Associa- 
tion with  such  monthly  reports  of  its  work  as  may  be 
required  by  the  Association. 

VIII. — Circulars  of  Information. 

All  information  which  is  of  general  interest  to  the  clinics 
belonging  to  the  Association,  and  all  rulings  concerning 
the  method  of  procedure  recommended  by  the  Association, 
shall  be  transmitted  by  the  Executive  Secretary  to  each 
clinic  in  the  form  of  a  Circular  of  Information,  two  copies 
being  sent  to  each  clinic,  one  to  the  physician-in-charge 
and  a  duplicate  to  the  supervising  nurse,  who  shall  keep 
such  circulars  on  file  in  a  binder  furnished  for  this  purpose. 

13 


CLINICS  AND  DISTRICTS 


H  DETT 


MANHATTAN 

Bellevue  Hospital  Clinic  (12)  Foot  E.  26th 

St.   Daily,  1  to  3  p.  m.    Children's  Clinic, 

Tuesday  and  Saturday,  1,30  to  3  p.  m. 
Flower  Hospital  Clinic  (15)  Eastern  Bou- 
levard and  63rd  St.  Monday,  Wednesday 

and  Saturday,  2.30  to  3.30  p.  m. 
German  Hospital  Clinic  (17)  76th  St.  and 

Park  Ave.     Daily,  3  to  4  p.  m. 
Good    Samaritan    Clinic    (10)    Essex   and 

Broome  Sts.     Daily,  2.30  to  4.30  p.  m. 
Gouverneur  Hospital  Clinic  (9)  Foot  Gou- 

verneur  Slip.    Monday,  Wednesday  and 

Friday,  2  to  4  p.  m.    Tuesday,  Thursday 

and  Saturday,  4  to  6  p.  m. 
Harlem  Hospital  Clinic  (2)  136th  St.  and 

Lenox  Ave.     Daily,  2.30  to  3.30  p.  M. 
Health  Department — East  Side  (11)  81  E.  2d 

St.    Daily,  10  a.  m.  to  4  p.  m.  Thursday 

and  Saturday,  8  to  9  p.  m. 
Health  Department— Italian  (19)  339  E.  109th 

St.    Daily,  10  a.  m.  to  12  m.    Tuesday, 

Thursday   and    Saturday,   2  to   4   p.   m. 

Tuesday,  8  to  9  p.  m. 
Health  Department— West  Side  (4)  307  W. 

33d  St.     Daily,  2  to  4  p.  m.    Thursday, 

8  to  9  P.  M. 
Tuberculosis   Hospital  Admission    Bureau 

(20)  426  First  Ave.   Daily,  9  a.m.  to  5  p.m. 
Morgagni  Clinic    (7)   169  VV.  Houston   St. 

Tuesday,  Thursday  and  Saturday,  2  to 

4  p.  M. 
Mt.   Sinai   Hospital   Clinic    (18)    Madison 

Ave.  and  100th  St.     Daily,  10  to  11  A.  m. 

Children's  Clinic,  Saturday,  2  to  4  p.  m. 
New  York   Dispensary  (8)   145  Worth  St. 

Daily,  11  a.  m.  to  12.30  p.  m. 
New  York  Hospital  Clinic  (s)  8  W.  16th  St. 

Daily,  1  to  3  P-  m. 
New  York  Throat,  Nose  and  Lung  Hospital 

Clinic  (14)  229  E.  57th  St.     Daily,  3  P.  M. 

and  8  p.  m. 
Presbyterian  Hospital  Clinic  (16)   70th  St. 

and  Madison  Ave.     Daily,  1.30  to  3  P.  M. 
St.  Bartholomew's  Clinic  (13)  209  E.  42nd 

St.     Tuesday,  Thursday  and  Saturday, 

2  to  4  P.  M. 

St.  Luke's  Hospital  Clinic  (1)  Amsterdam  Ave.  and  113th  St.  Monday,  Wed- 
nesday and  Friday,  2  to  3  p.  m. 

St.  Vincent's  Hospital  Clinic  (6)  149  W.  nth  St.  Monday,  Wednesday  and 
Friday,  10  to  n  a.  m. 

Vanderbilt  Clinic  (3)  Amsterdam  Ave.  and  60th  St.  Daily,  1  to  2.30  p.  m. 
Monday,  Wednesday  and  Friday,  9  to  10.30  a.  m.     Children's  Clinic,  Saturday, 


THE  BRONX 


Daily,  2  to  4  p.  m. 
Daily,  10  a.  m.  to  12  m.    Tues- 


Health  Department— Northern  (1)  3d  Ave.  and  St.  Paul's  PI 

Thursday,  8  to  9  p.  m. 
Health  Department — Southern  (2)  493  E.  139th  St 

day,  8  to  9  p.  m. 

RICHMOND 

Health  Department,   Bay   Street,   Stapleton,    S.   I.     Tuesdays,  Thursdays   and 

Saturdays,  2  to  4  p.  m. 
Note  :— All  applicants  should  apply  to  the  tuberculosis  clinic  of  the  district  in 

which  they  live. 


COLUMBIA  UNIVERSITY  LIBRARIES 

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IT4S 


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New  York  (   ity)     Dept.   of  health. 


